Information

  • Enter an Audit Title of "Risk Review" ...

  • Audit Title

  • Customer Name

  • Address
  • Contract / Job Number

  • Conducted on

  • Prepared by

Section A - Site Management

  • Date of original risk assessment or previous review:

  • Define the scope of the risk assessment being reviewed. I.E. which buildings and water systems

  • Is the name of the nominated responsible person up to date

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  • Details / Priority /Action By Whom & Date

  • Is the name of the nominated deputy responsible person up to date

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  • Details / Priority /Action By Whom & Date

  • Has the occupancy level of the building(s) changed since the assessment was completed

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  • Details / Priority /Action By Whom & Date

  • Has the building had any change of use since the assessment was completed

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  • Details / Priority /Action By Whom & Date

  • Has the susceptibility level of the building occupants changed

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  • Details / Priority /Action By Whom & Date

  • Has there been any local construction of water systems, outside the building(s), that may affect the risk

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  • Details / Priority /Action By Whom & Date

  • Is there any evidence of site staff being trained in Legionella awareness and their responsibilities within the control scheme

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  • Details / Priority /Action By Whom & Date

  • Is there a written procedure to define the action to be taken if Legionella bacteria are detected in samples taken from site

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  • Details / Priority /Action By Whom & Date

  • Is there a written procedure to define the action to be taken if a case of Legionnaire’s disease is suspected from water systems on the site

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  • Details / Priority /Action By Whom & Date

  • Is there a written procedure regarding when and how to alternate hot or cold water pumps

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  • Details / Priority /Action By Whom & Date

  • Are the responsibilities for carrying out the tasks within the control scheme clearly defined

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  • Details / Priority /Action By Whom & Date

Section B - Assets, Previous Recommendations & Schematics

  • By checking the available records, can it be shown that all recommendations of the risk assessment have been implemented

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  • Details / Priority /Action By Whom & Date

  • Are there schematic diagrams for every water system

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  • Details / Priority /Action By Whom & Date

  • Are the schematic drawings accurate with regard to the locations that they supply

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  • Details / Priority /Action By Whom & Date

  • Do the schematic drawings show enough detail so that they are not ambiguous

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  • Details / Priority /Action By Whom & Date

  • Is the outlet asset register accurate? I.e. are all of the outlet types and number defined in each location where water is used

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  • Details / Priority /Action By Whom & Date

  • Is the “fixed asset” register accurate? I.e. are all of the cold-water storage tanks and hot water vessels recorded

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  • Details / Priority /Action By Whom & Date

  • Is a supplementary biocide being dosed into any of the systems and has this been installed since the previous risk assessment

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  • Details / Priority /Action By Whom & Date

  • Complete inspection sheets for all cold-water tanks and hot water vessels and make recommendations for remedial action as required

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  • Details / bPriority /Action By Whom & Date

Section C - Cold Water Tank Inspections

  • Is there a secure, close fitting lid fitted

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Is there a lid vent (tank breather) fitted and is it in good condition

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Is there an overflow screen fitted and is it in good condition

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Is the tank well insulated from heat gain

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Is the tank corroded

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Is there any evidence of scale deposition

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Describe the level of sediment on the base of the tank. (Percentage covered)

  • Does the level control valve shut off before the overflow level is reached

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Does the inlet supply valve shut off the supply

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Does the outlet valve shut off the outlet

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  • Tank Number / Details / Priority /Action By Whom & Date

  • Record the stored water temperature as far away as possible from the inlet valve.

  • Record the inlet temperature at the mains inlet.

Section D - Hot Water Vessel Inspections

  • Was an internal inspection of the vessel undertaken

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Were the internal surfaces of the vessel covered in scale deposits

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Were there any signs of internal corrosion

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Is the vessel well insulated to prevent heat loss

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Does the vessel drain valve operate safely

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Was the vessel drain flushed until clear water was achieved

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  • HWS Number / Details / Priority /Action By Whom & Date

  • Is there a flow/storage temperature gauge fitted

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  • HWS Number / Details / Priority /Action By Whom & Date

  • What is the stored water temperature

  • Is there a return line temperature gauge fitted

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  • HWS Number / Details / Priority /Action By Whom & Date

  • What is the return water temperature

  • Is the return pump operating

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  • HWS Number / Details / Priority /Action By Whom & Date

Section E - Control Scheme Monitoring Records

  • Are the temperature records for all cold water systems complete

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  • Details / Priority /Action By Whom & Date

  • Have all non-conformances in cold-water temperature been investigated and addressed

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  • Details / Priority /Action By Whom & Date

  • Are the temperature records for all hot water systems complete

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  • Details / Priority /Action By Whom & Date

  • Have all non-conformances in hot water temperature been investigated and addressed

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  • Details / Priority /Action By Whom & Date

  • Are there full records of flushing for any identified “low use” outlets

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  • Details / Priority /Action By Whom & Date

  • Has the risk assessment been reviewed and records produced at the agreed frequency

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  • Details / Priority /Action By Whom & Date

  • Are there records to demonstrate that showers have been inspected and disinfected at least quarterly

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  • Details / Priority /Action By Whom & Date

  • Are there records of duty/standby pumps being alternated on DHWS return

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  • Details / Priority /Action By Whom & Date

  • Are there suitable records of any fitted biocide dosing system

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  • Details / Priority /Action By Whom & Date

  • Are there records of cold-water tank and hot water vessel inspection

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  • Details / Priority /Action By Whom & Date

Summary

  • Assessors comments and summary

  • Photographic Evidence ( if applicable )

  • Item
  • Description

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.